Minnesota Session Laws - 1990, Regular Session

  

                         Laws of Minnesota 1990 

                        CHAPTER 454-S.F.No. 1696 
           An act relating to human services; including the 
          commissioners of commerce and health in designing the 
          demonstration project for uninsured low-income 
          persons; clarifying eligibility and enrollee 
          participation requirements for the demonstration 
          project; amending Minnesota Statutes 1988, section 
          256B.73. 
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
    Section 1.  Minnesota Statutes 1988, section 256B.73, is 
amended to read: 
    256B.73 [DEMONSTRATION PROJECT FOR UNINSURED LOW-INCOME 
PERSONS.] 
    Subdivision 1.  [PURPOSE.] The purpose of the demonstration 
project is to determine the need for and the feasibility of 
establishing a statewide program of medical insurance for 
uninsured low-income persons.  
    Subd. 2.  [ESTABLISHMENT: GEOGRAPHIC AREA.] The 
commissioner of human services shall cooperate with a local 
coalition to establish a demonstration project to provide low 
cost medical insurance to uninsured low-income persons in Cook, 
Crow Wing, Lake, St. Louis, Carlton, Aitkin, Pine, Itasca, and 
Koochiching counties except an individual county may be excluded 
as determined by the county board of commissioners.  The 
coalition shall work with the commissioner commissioners of 
human services, commerce, and health and potential demonstration 
providers as well as other public and private organizations to 
determine program design, including enrollee eligibility 
requirements, benefits, and participation. 
    Subd. 3.  [DEFINITIONS.] For the purposes of this section, 
the following terms have the meanings given:  
    (1) "commissioner" means the commissioner of human 
services; 
    (2) "coalition" means an organization comprised of members 
representative of small business, health care providers, county 
social service departments, health consumer groups, and the 
health industry, established to serve the purposes of this 
demonstration; 
    (3) (2) "demonstration provider" means a Minnesota 
corporation regulated under chapter 62A, 62C, or 62D; 
    (4) (3) "individual provider" means a medical provider 
under contract to the demonstration provider to provide medical 
care to enrollees; and 
    (5) (4) "enrollee" means a person eligible to receive 
coverage according to subdivision 4.  
    Subd. 4.  [ENROLLEE ELIGIBILITY REQUIREMENTS.] To be 
eligible for participation in the demonstration project, an 
enrollee must:  
    (1) not be eligible for Medicare, medical assistance, or 
general assistance medical care; and 
    (2) have an income not more than 200 percent of the 
Minnesota income standards by family size used in the aid to 
families with dependent children program; and 
    (3) have no medical insurance or health benefits plan 
available through employment or other means that would provide 
coverage for the same medical services as provided by this 
demonstration. 
    Subd. 5.  [ENROLLEE BENEFITS.] (a) Eligible persons 
enrolled by a demonstration provider shall receive a health 
services benefit package that includes health services which the 
enrollees might reasonably require to be maintained in good 
health, including emergency care, inpatient hospital and 
physician care, outpatient health services, and preventive 
health services, except that. 
    (b) Services related to chemical dependency, mental 
illness, vision care, dental care, and other benefits may be 
excluded or limited upon approval by the commissioner 
commissioners.  The coalition may petition the commissioner of 
commerce or health, whichever is appropriate, for waivers that 
allow these benefits to be excluded or limited.  
     (c) The commissioner commissioners, the coalition, and 
demonstration providers shall work together to design a package 
of benefits or packages or of benefits that can be provided to 
enrollees for an affordable monthly premium. 
    Subd. 6.  [ENROLLEE PARTICIPATION.] An enrollee is not 
required to furnish evidence of good health.  The demonstration 
provider shall accept all persons applying for coverage who meet 
the criteria in subdivision 4, subject to the following 
provisions: 
    (a) Enrollees will be required to pay a sliding fee on a 
monthly basis for health coverage through the demonstration 
project.  Except for any required copayments, the sliding fee 
should be considered payment in full for the coverage provided.  
The sliding fee shall be based on the enrollee's income and 
shall not exceed 50 percent of the rate that would be paid to a 
prepaid plan serving general assistance medical care recipients 
in the same geographic area.  
    (b) The demonstration provider may terminate the coverage 
for an enrollee who has not made payment within the first ten 
calendar days of the month for which coverage is being 
purchased.  The termination for nonpayment shall be retroactive 
to the first day of the month for which no payment has been made 
by the enrollee.  
    (c) An enrollee who either requests termination of coverage 
under the demonstration or who allows coverage to terminate due 
to nonpayment of the required monthly fee may be required to 
furnish evidence of good health prior to being reinstated in the 
demonstration.  As an alternative to evidence of good health, 
the enrollee may furnish evidence of having been eligible for 
health care services under a plan with similar benefits.  
    (d) The demonstration provider shall establish limits of 
enrollment which allow for a sufficient number of enrollees to 
constitute a reasonable demonstration project.  These limits 
shall be established by county within the project area.  The 
coalition will assure that participants receive adequate 
information about the demonstration nature of the project.  The 
coalition will assist enrollees with finding alternative 
coverage at the conclusion of the demonstration project. 
    Subd. 7.  [CONTRACT WITH DEMONSTRATION PROVIDER COALITION.] 
The commissioner of human services shall contract with the 
coalition to administer and direct the demonstration project and 
to select and retain the demonstration provider for the duration 
of the project.  This contract shall be for 24 months with an 
option to renew for no more than 12 months.  This contract may 
be canceled without cause by the commissioner upon 90 days' 
written notice to the demonstration provider or by the 
demonstration provider with 90 days' written notice to the 
commissioner.  The commissioner shall assure the cooperation of 
the county human services or social services staff in all 
counties participating in the project.  
    Subd. 8.  [MEDICAL ASSISTANCE AND GENERAL ASSISTANCE 
MEDICAL CARE COORDINATION.] To assure enrollees of uninterrupted 
delivery of health care services, the commissioner may pay the 
premium to the demonstration provider for persons who become 
eligible for medical assistance or general assistance medical 
care.  To determine eligibility for medical assistance, any 
medical expenses for eligible services incurred by the 
demonstration provider shall be considered as evidence of 
satisfying the medical expense requirements of section 256B.056, 
subdivisions 4 and 5.  To determine eligibility for general 
assistance medical care, any medical expenses for eligible 
services incurred by the demonstration provider shall be 
considered as evidence of satisfying the medical expense 
requirements of section 256D.03, subdivision 3.  
    Subd. 9.  [WAIVER REQUIRED.] No part of the demonstration 
project shall become operational until any required waivers of 
appropriate federal regulation regulations are obtained from the 
health care financing administration.  
    Sec. 2.  [EFFECTIVE DATE.] 
    Section 1 is effective the day following final enactment. 
    Presented to the governor April 12, 1990 
    Signed by the governor April 16, 1990, 4:18 p.m.